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Tuesday, December 18, 2012

Sleep Disorders: The Effectiveness of CAM Practices

People who have trouble sleeping may try dietary supplements, relaxation therapies, or other forms of complementary and alternative medicine
(CAM) in an effort to fall asleep faster, stay asleep longer, and
improve the overall quality of their sleep. If you are
considering a CAM therapy for sleep problems, this information can help
you talk with your health care provider about it.

About Sleep Disorders
Chronic, long-term sleep disorders affect millions of Americans each
year. These disorders and the sleep deprivation they cause can interfere
with work, driving, social activities, and overall quality of life, and
can have serious health implications. Sleep disorders account for an
estimated $16 billion in medical costs each year, plus indirect costs
due to lost productivity and other factors.

There are more than 80 defined sleep disorders. Insomnia—difficulty
falling asleep, difficulty staying asleep, and/or poor sleep quality—is
one of the most common sleep disorders. Insomnia tends to increase with
age, and is often associated with an underlying medical or psychiatric
condition. Other sleep disorders include sleep apnea (breathing
interruptions during sleep), restless leg syndrome (a tingly or prickly
sensation in the legs), and narcolepsy (daytime "sleep attacks").

Lifestyle changes—for example, establishing a regular sleep schedule,relaxing before bedtime, exercising regularly, and avoiding alcohol,
caffeine, and nicotine—can sometimes improve sleep quality. (A common
misconception is that drinking alcohol will aid sleep; although it can
bring on a light sleep, alcohol actually robs people of the deeper
stages of sleep.) Many prescription medications and over-the-counter
sleep aids are widely advertised and used for insomnia; most have side
effects and are intended for short-term use. Evidence suggests that
cognitive-behavioral (nondrug) therapies for insomnia may have long-term
benefits. People with insomnia may also try dietary supplements and
other CAM therapies.

CAM Use for Insomnia
In 2002 and 2007, the National Health Interview Survey (NHIS) asked
participants about CAM use. In 2002, 2.2 percent of respondents who used
some form of CAM in the past 12 months said they used it for insomnia
or trouble sleeping; in 2007, that figure was 1.4 percent.

An analysis of data from the 2002 NHIS found that 17.4 percent of all
participants said they regularly had insomnia or trouble sleeping in
the past 12 months; most who reported insomnia also reported other
medical/psychiatric conditions, such as anxiety or depression, chronic
heart failure, diabetes, hypertension, and obesity. Among participants
with insomnia, 4.5 percent (which translates to a total of 1.6 million
U.S. adults) used some form of CAM to treat their condition—primarily
biological/herbal therapies (64.8 percent) or mind-body/relaxation
therapies (39.1 percent). Most found these therapies helpful.

Among the CAM approaches that people use for insomnia are:

Herbs, including aromatherapy, chamomile tea, and herbal supplements such as valerian and various "sleep formula" products

Research on CAM and insomnia has produced promising results for some
CAM therapies. However, evidence of effectiveness is still limited for
most therapies, and additional research is needed. This section
summarizes what is known about some of the CAM approaches that people
use for insomnia.

Aromatherapy using essential oils
from herbs such as lavender or chamomile is a popular sleep aid;
preliminary research suggests some sleep-inducing effects, but more
studies are needed.

The herb chamomile is commonly used as a bedtime tea, but scientific evidence of its effectiveness for insomnia is lacking.

The herb kava has been used for insomnia, but there
is no evidence of its efficacy. The U.S. Food and Drug Administration
has issued a warning that kava supplements have been linked to a risk of
severe liver damage.

The herbal supplement valerian
is one of the most popular CAM therapies for insomnia. Several studies
suggest that valerian (for up to 4-to-6 weeks) can improve the quality
of sleep and slightly reduce the time it takes to fall asleep. However,
not all of the evidence is positive. One systematic review of the
research concluded that although valerian is commonly used as a sleep
aid, the scientific evidence does not support its efficacy for insomnia.
Researchers have concluded that valerian appears to be safe at
recommended doses for short-term use. Some "sleep formula" products
combine valerian with other herbs such as hops, lavender, lemon balm, and skullcap.
Although many of these other herbs have sedative properties, there is
no reliable evidence that they improve insomnia or that combination
products are more effective than valerian alone.

Melatonin and Related Supplements

Like valerian, melatonin
supplements (melatonin is a naturally occurring hormone associated with
sleep) are widely used and researched for insomnia. Although more
research is still needed, studies suggest that melatonin can help
elderly people with insomnia fall asleep faster, and may also be
beneficial for other people with insomnia; however, effects are
generally small, with larger effects observed in patients whose sleep
problems are caused by a circadian rhythm abnormality (disruption of the
body's internal "clock"). Studies indicate that melatonin also appears
to be safe at recommended doses for short-term use.

Dietary supplements containing melatonin "precursors"—L-tryptophan and 5-HTP—are
also used as sleep aids. (The amino acid L-tryptophan is converted to
5-HTP, which is converted to serotonin and then melatonin.) However,
these supplements have not been proven effective in treating insomnia,
and there are concerns that they may be linked to eosinophilia-myalgia
syndrome (EMS), a complex and debilitating systemic condition with
multiple symptoms including severe muscle pain.

Other CAM Approaches

Traditional Chinese medicine commonly uses acupuncture
to treat insomnia. A review of available studies found some evidence of
benefits, but many studies had design flaws that make it difficult to
draw firm conclusions.

There is scientific evidence that sound and music therapy can have sleep benefits for older adults and children.

Studies suggest thatrelaxation techniques may help
people with insomnia, although the effects appear to be short-lived.
Cognitive forms of relaxation (such as mindfulness) have had slightly better results than somatic forms (such as progressive muscle relaxation). Preliminary studies suggest that yoga
may also improve sleep quality. In addition, when these forms of
relaxation are combined with other components of cognitive-behavioral
therapy (e.g., sleep restriction and stimulus control), lasting
improvements in sleep have been observed. Again, additional research is
needed in these areas.

The National Center for Complementary and Alternative Medicine
(NCCAM) funds clinical trials that look at CAM for sleep disorders.
Recent projects include studies of:

Hypnosis to relieve sleep impairment in people with posttraumatic stress disorder

Melatonin supplements as a sleep aid for people with hypertension

Mindfulness-based stress reduction to improve sleep quality

Valerian for improving sleep in healthy, older adults and in patients with Parkinson's disease

Yoga as a treatment for insomnia.

In addition to clinical trials, NCCAM also supports basic
science research aimed at understanding the underlying biological
mechanisms of CAM therapies, including those used to treat
sleep disorders.

If You Are Considering CAM for Sleep Problems

Talk to your health care providers. Tell them
about the therapy you are considering and ask any questions you may
have. They may know about the therapy and be able to advise you on its
safety, use, and likely effectiveness in relieving your sleep problems.
Because trouble sleeping can be an indication of a more serious
condition, it is especially important to discuss any sleep-related
symptoms (such as snoring or daytime fatigue) with your health care
providers before trying a CAM approach.

Be cautious about using any sleep product—prescription medications,
over-the-counter drugs, or CAM dietary supplements. Find out about
potential side effects and the effects of long-term use and use of more
than one product at a time.

If you are considering herbal or other dietary supplements,
keep in mind that "natural" does not always mean safe. For example, the
herbs comfrey and kava can cause serious harm to the liver. Also, a
manufacturer's use of the term "standardized" (or "verified" or
"certified") does not necessarily guarantee product quality or
consistency. Herbal or other dietary supplements can act in the same way
as drugs. They can cause medical problems if not used correctly, and
some may interact with medications you are already taking. The health
care providers you see about your sleep problems can advise you. It is
especially important to consult your health care provider if you are
pregnant or nursing a child, or if you are considering giving a child a
dietary supplement.

If you are considering a practitioner-provided CAM therapy such as
acupuncture, check with your insurer to see if the services will be
covered, and ask a trusted source (such as your doctor or a nearby
hospital or medical school) to recommend a practitioner.

Tell all your health care providers about any complementary and
alternative practices you use. Give them a full picture of what you do
to manage your health. This will help ensure coordinated and safe care.

National Institutes of Health. State of the Science Conference Statement on Manifestations and Management of Chronic Insomnia in Adults. NIH Consensus and State-of- the-Science Statements. 2005;22(2):1–30.

These
statements have not been approved by the U.S. Food and Drug Administration
(FDA). This information is not intended
to diagnose, treat, cure or prevent any disease.

Information conveyed herein is
based on pharmacological and other records - both ancient and modern. No claims
whatsoever can be made as to the specific benefits accruing from the use of any
herb, essential oil, dietary and/or nutritional supplement, home remedy, or
therapeutic regimen. Holistic
Lifestyle Community Blog has provided this material for general information and
education purposes only. It is not intended as a substitute for or to take the
place of medical advice. If you have a medical emergency call 9-1-1. Before
beginning any type of natural, integrative or conventional treatment regimen,
it is advisable to seek the advice of a licensed health care professional. The
mention of any product, service, or therapy is not an endorsement by Holistic Lifestyle
Community Blog. Any mention in the Holistic Lifestyle Community Blog of a
specific brand name is not an endorsement of the product.

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